{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:10:52Z","timestamp":1777497052340,"version":"3.51.4"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>\n            Objective\u2003We sought to assess the association of hemoglobin A1c (HbA1c) with adverse perinatal outcomes in obese women with gestational diabetes mellitus (GDM).<\/jats:p><jats:p>\n            Study Design\u2003This was a secondary analysis of a multicenter randomized controlled trial assessing early (14\u201320 weeks) versus routine (24\u201328 weeks) screening for GDM in obese women. Women were included if they were diagnosed with GDM at either time during pregnancy and had a HbA1c result available. The primary exposure was HbA1c at 24 to 28 weeks. The primary outcome was a composite of macrosomia, primary cesarean, pregnancy-induced hypertension, shoulder dystocia, neonatal hypoglycemia, or hyperbilirubinemia. Receiver operating characteristics (ROC) curves were used to assess the association of HbA1c with the composite outcome. The Liu method was used to select an optimal HbA1c cutoff, and the incidence of the outcome compared.<\/jats:p><jats:p>\n            Results\u2003Of 125 women with GDM, 93 (74%) had a HbA1c at 24 to 28 weeks and 103 (82.4%) had a HbA1c at 14 to 20 weeks. Baseline characteristics were balanced between groups above and below the cutoff. The area under the ROC curve for HbA1c and its association with the adverse perinatal composite outcome was 0.6 (95% confidence interval [CI]: 0.5\u20130.7). The frequency of the primary outcome was similar among women with low and high HbA1c at 24 to 28 weeks (adjusted relative risk, 1.12, 95% CI: 0.97\u20131.29). Compared with women with a decreasing HbA1c during pregnancy, women with a stable or increasing HbA1c did not have a significant increase in the primary adverse perinatal composite outcome. However, the frequency of preterm delivery was higher among women with stable or increasing HbA1c compared with those with a decreasing HbA1c (26.1 vs. 6.7%, p\u2009=\u20090.03).<\/jats:p><jats:p>\n            Conclusion\u2003A single HbA1c in women with GDM is not associated with a composite perinatal adverse outcome, but a HbA1c that increases or remains stable between 14 to 20 and 24 to 28 weeks is associated with an increase in preterm delivery.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0041-1740060","type":"journal-article","created":{"date-parts":[[2021,11,28]],"date-time":"2021-11-28T23:31:51Z","timestamp":1638142311000},"page":"449-456","source":"Crossref","is-referenced-by-count":4,"title":["Value of HbA1c in Obese Women with Gestational Diabetes"],"prefix":"10.1055","volume":"39","author":[{"given":"Ayamo","family":"Oben","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Alabama, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Jauk","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Battarbee","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Alabama, Birmingham, Alabama"},{"name":"University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherri","family":"Longo","sequence":"additional","affiliation":[{"name":"Ochsner Health System, New Orleans, Louisiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeff","family":"Szychowski","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama"},{"name":"University of Alabama at Birmingham, Department of Biostatistics, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Tita","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Alabama, Birmingham, Alabama"},{"name":"University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama"},{"name":"University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorie","family":"Harper","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Alabama, Birmingham, Alabama"},{"name":"University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,11,28]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.diabres.2018.05.010","article-title":"Prevalence of gestational diabetes and subsequent type 2 diabetes among U.S. women","volume":"141","author":"S S Casagrande","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s10995-014-1553-5","article-title":"Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009","volume":"19","author":"A Correa","year":"2015","journal-title":"Matern Child Health J"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s00592-014-0668-x","article-title":"Low-educated women have an increased risk of gestational diabetes mellitus: the generation R study","volume":"52","author":"S H Bouthoorn","year":"2015","journal-title":"Acta Diabetol"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1016\/j.ajog.2004.03.074","article-title":"The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control","volume":"191","author":"Y Yogev","year":"2004","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.ajog.2004.06.057","article-title":"The influence of obesity and diabetes on the risk of cesarean delivery","volume":"191","author":"H M Ehrenberg","year":"2004","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"365.e1","DOI":"10.1016\/j.ajog.2008.06.031","article-title":"Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus","volume":"200","author":"L J England","year":"2009","journal-title":"Am J Obstet Gynecol"},{"issue":"S 01","key":"ref7","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.2337\/dc19-S006","article-title":"6. 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